Femoral insertion site of the graft used to replace the medial patellofemoral ligament influences the ligament dynamic changes during knee flexion and the clinical outcome

Sanchis-Alfonso, Vicente; Ramírez-Fuentes, Cristina; Montesinos-Berry, Erik; Doménech, Julio; Martí‐Bonmatí, Luis

doi:10.1007/s00167-015-3905-0

Cited by 44 publications

(80 citation statements)

References 38 publications

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“…Static and dynamic reconstructions show MPFL isometry between 0 • and 90 • [9,13]. In a static/anatomic MPFLr, the graft is isometric in all the cases between 0 • and 30 • of knee flexion [13]. In 83% of cases, the graft is isometric from 0 • to 60 • [13].…”

Section: Introductionmentioning

confidence: 94%

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Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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Objectives: To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee. Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction). Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee. Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

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Section: Introductionmentioning

confidence: 94%

“…This type of reconstruction is therefore a less rigid reconstruction [7][8][9][10][11][12]. Static and dynamic reconstructions show MPFL isometry between 0 • and 90 • [9,13]. In a static/anatomic MPFLr, the graft is isometric in all the cases between 0 • and 30 • of knee flexion [13].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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“…In our study the absolute numbers are likely to be inaccurate, but the surgeon can consider the relative lengths and where they might want the tunnel to go using the intra-operative bony landmarks. Ultimately the position is decided intra-operatively [16]. …”

Section: Discussionmentioning

confidence: 99%

The trochlear isometric point is different in patients with recurrent patellar instability compared to controls: a radiographical study

Campos

Soogumbur

McNamara

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to investigate the theoretical isometric point based of the curve of the femoral groove and relating it to the origin of the MPFL femoral tunnel on lateral radiograph by comparing a patellar instability cohort with a control cohort.MethodsFrom a Patellar Instability database the radiographs of 40 consecutive patients were analysed to define Schöttle’s point, and the arc of the circle of the trochlear groove. A comparison population of 20 radiographs from comparable patients with tibiofemoral joint disorders was used as a control. The distance from Schöttle’s point to the most anterior part of the groove (extension) was also compared to the distance to the distal end of the roof of the notch (flexion).ResultsThe trochlea was circular in the controls but not the Patellofemoral Instability cohort where trochlear dysplasia is usually present. The difference between the extension and flexion length was a mean of − 2.0 ± 0.5 mm in the controls and + 6.0 ± 0.5 mm in the patellofemoral cohort. In neither cohort did the centre of the circle correspond to Schöttle’s point. The extension distance correlated with the boss height.ConclusionsThe dysplastic trochlea is not circular and the centre of the best matched circle was different to the control trochleae which were circular. The circle centres did not correlate with Schöttle’s point for either cohort, and was more proximal in the Patellofemoral Instability cohort.Clinical relevanceFor the MPFL to have equal tension throughout flexion within the groove, the length should not change. In normal knees the MPFL does not behave isometrically. The change in length, as measured from Schöttle’s point to the trochlea, was greater for patellofemoral instability patients explaining why an isolated MPFL reconstruction in the presence of severe trochlear dysplasia risks poor outcomes. Level of evidence III.

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“…Three-dimensional CT could be clinically useful in planning revision surgery in patients with AKP after medial patellofemoral ligament reconstruction to detect femoral tunnel malposition (figure 8). 46…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of anterior knee pain

et al. 2016

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Femoral insertion site of the graft used to replace the medial patellofemoral ligament influences the ligament dynamic changes during knee flexion and the clinical outcome

Abstract: III.

Cited by 44 publications

References 38 publications

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

The trochlear isometric point is different in patients with recurrent patellar instability compared to controls: a radiographical study

Diagnosis and treatment of anterior knee pain

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